How to Virtually Expand the Emergency Department

Many emergency departments suffer from overcrowding: From 1997 to 2007, ED visit rates increased at twice the rate of growth of the U.S. population, according to a study in JAMA. Additionally, since 1990, the number of hospital EDs has decreased by about 10 percent — but the number of visits to EDs has increased 40 percent, according to an EmCare whitepaper.

Baylor University Medical Center in Dallas used to struggle with that issue, but took multiple steps to better manage ED capacity. For instance, the hospital expanded its ED by 58,000 square feet.

In addition to physically expanding its ED, BUMC's ED also underwent a "virtual" expansion after the hospital deployed a Rapid Medical Assessment system with EmCare, according to the whitepaper.

The RMA system involves a team of providers, including a physician, registered nurse and ED technician, and it establishes sub-waiting rooms with chairs for ED patients with urgent, not emergent, conditions. The nurse selects patients who can be handled more quickly and the physician evaluates the patients and orders any necessary tests. Through the program, the patient is only in an ED bed while he or she is being actively treated — the rest of their visit is spent in the sub-waiting rooms.

"RMA is used when there are more people than beds," Dighton Packard, MD, EmCare's CMO, said in the whitepaper. "We try to find patients who don't need to lie down. We see them using RMA and put them in a chair. This allows us to use each bed more efficiently."

The RMA program coupled with BUMC's other efforts to increase ED efficiency led to a 40 percent decrease in patient length-of-stay. Also, the percentage of urgent patients who left without being seen dropped to 2 percent from 14 percent, according to the whitepaper.